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General NPI Number Information
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NPI Number | 1710438692
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Entity Type | Organization
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Legal Business Name | SC DHEC
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 4050 BRIDGE VIEW DR SUITE 600
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City | N CHARLESTON
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State | SC
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Zip | 29405-7488
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Country | US
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Telephone | 843-953-0272
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Fax |
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Provider Business Mailing Address
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Address Line | 4050 BRIDGE VIEW DR SUITE 600
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City | N CHARLESTON
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State | SC
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Zip | 29405-7488
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | LEAH WILLIS
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Credential | RN
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Telephone | 843-870-1321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 60412
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License Number State | SC
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